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This last decade has seen a flurry of conceptual thinking on topics related to the mass movement of people across borders. Whether regarding membership, culture, identity, law or sovereignty itself, an impressive intellectual effort has been made to catch up with the vertiginous changes of a rapidly globalizing world in which freedom of mobility seems to be decreasing rather than increasing. The topic of asylum, or the protection of refugees, however, has remained marginal in this enterprise, and has not received the same ambitious, concerted and comprehensive philosophical attention that many of the other themes have. That is, until now. Nanda Oudejans’s dissertation, Asylum: A Philosophical Inquiry into the International Protection of Refugees, was defended cum laude in Tilburg in September 2011, and lauded with the Max van der Stoel Human Rights Award in 2012, and with the Dissertation Award 2013 of the Netherlands Association for Philosophy of Law.

illustrating some parts of the subject which had been imperfectly considered in the dissertation. The whole makes 600 pages of fair modern printing besides engravings, which, being on a larger scale, are contained in a separate volume.
In considering a work of such magnitude and importance, we shall attend with minuteness to some particular chapters, and offer a general view of the remainder. By these means, -we can enable the author to speak for himself whenever we notice his opinions, a method which we always prefer as the only fair mode of criticism. We cannot but condemn an affectation lately introduced by reviewers, of endeavouring to give all their articles the appearance of original essays. By this artful contrivance, a hackney-writer borrows as much as he pleases from the work before him without acknowledging the source, and, when he censures his author, often palms opinions upon him not to be met with in his writings. In other words, by appropriating all that is good to himself, and imputing whatever absurdity he thinks proper to his author, it is easy to make himself appear to advantage, and to dress his author like a scaramouch. Thus, the critic appears as the principal performer in the play, and the author is introduced as a butt in the afterpiece.
The first part is on Diseases of Arteries in General. In the in* troduction to this division, Mr. H. remarks, " that arteries are composed of [we suspect he means have as part of their composition] blood vessels, nerves, and absorbents, which render them liable to the same morbid alterations, and endow them witli the same powers of reparation as soft parts in general." ho. Ip8. 5 Thus, 150 Critical Analysis. <6 Thus, (continues he,) the coats of arteries inflame and pass through all the staged of adhesiouy suppuration, or gangrene, in the sanie manner as the skin, a gland, or a muscle. But these elementary textures are in arteries so modified or arranged, as to form structures possessing peculiar properties, essential to the functions of the vessel. From this circumstance, arteries a?e liable to particular diseases arising from the peculiarities of their formation and functions. Thus, certain depositions and alterations take place in their coats, which we do not meet with in other structures; and their cavities undergo changes, which depend upon the actions of the vessels, and their subserviency to other organs. " With this view of the subject, I shall first consider those morbid changes which arteries undergo in common with soft parts in general; namely, inflammation and its consequences?the effusion of lymph and adhesion, suppuration, ulceration, and gangrene ; and, secondly, those changes which arise from peculiarities in the structure of arteries, as calcareous depositions, and various morbid alterations in their coats, and preternatural dilatation of their cavities; and I shall then consider the subject of aneurism, as arising from one or other of these previous changes, or from accidental violence." ; The first section is on Inflammation of the Coats of Arteries. The grand object of this section is to shew that " though the internal coat of an artery differs essentially from every other membrane in the body?still, in one circumstance, it bears a striking analogy to serous membrane, namely, in its tendency to assume the adhesive inflammation." We cannot object to these positions, but we sincerely wish more attention were paid to the imperfect knowledge of those numerous readers who, we trust, will be enlightened by the industry, and we ought to add, by the genius, of this writer. For these, a short chapter on the Structure of Arteries; another, on the Serous Membranes, or on Membranes in General; and, another, on the Adhesive Inflammation, would have been very useful, ?very little more than definitions, with a reference to the various writers, might have been sufficient. It is to be remarked, that these terms are not only adopted from different authors, but even from authors of different nations, speaking different languages, and, perhaps, not sufficiently acquainted with each other to admit of their immediate coalescence without some introduction. Some of our readers, who left school when we did, and have since been engaged in the fatigues of provincial practice, may not be aware that of late it has been the custom, we presume for convenience, to call those membranes which line cavities serous membranes, because, under disease? serum is effused from them.
Mr. Hodgson oil Diseases of Arteries and Veins. 131 them. But this is neither their constant, nor even their most common, mode of action under inflammation, nor is it the kind of action which Mr. Hodgson wishes to describe in inflamed arteries, and in the manner in which he compares them to such membranes. " Although the internal coat of an artery differs essentially from every other membrane in the body, in its extreme tenuity and elasticity, the facility with which it is ruptured, and the peculiar unctuous appearance of its internal surface, still in one circumstance it bears a striking analogy to serous membranes, namely, in its tendency to assume the adhesive inflammation. This property is in blood vessels, as in all organs, the first agent of repara. tion in injuries from accident or disease, and is surprisingly ma. nifested in the processes which effect the cure of a wounded or divided artery. The inflammation which is excited by the injury, produces an effusion of lymph which seals the extremity of the divided vessel, and, extending to its internal coat, becomes the basis of adhesion and final obliteration. Punctured arteries also are united by the same adhesive process that repairs wounds in general. If irritation be excited in the coats of an artery by pressure, the adhesive inflammation is the consequence; an effusion of ymph takes place into the cellular membrane that connects the oats of the vessel, and into its cavity ; its sides coalesce, and it is endered impervious. This effect of pressure upon an artery is frustrated by the obliteration of blood vessels compressed by largfc t'uours, and by that cure which aneurisms occasionally undergo frtn the pressure of the sac upon the superior or inferior portion of >he artery. The same adhesive process frequently prevents hasojrrhage where abscesses or extensive ulcerations exist In the neigibourhood of large blood vessels; for the inflammation which precedes the suppuration has in such cases produced an effusion of lymphbetween the coats and into the cavity of the artery, whereby it is obiterated. Thus, in cases of vomica, where the substance 'of the lings is much consumed, htemorrhage is prevented by the closure <f the branches of the pulmonary and bronchial arteries by the achesive inflammation. " The qost perfect demonstration, however, of the effect of acute inflanmation upon the internal coat of an artery, is probably to be met with in those cases where the disease appears to have extended to tie vessel from contiguous parts. The following case of extensive inflammation of the thoracic viscera, in which the disease exfcted also in the internal coat of the aorta, and had produced an effusion of lymph into the cavity of that vessel, was com* municated to me by my friend, Dr. Farre." We wish our readers to attend carefully to the above passage, and to cur remarks, that by thus clearing the ground in limine, we may meet with fewer difficulties in our progress. The analogy between the internal coats of an artery and serous membranes, is in their tendency to assume ads 2 hesive 133 ? Critical AnalysisJ hesive inflammation," and this adhesive inflammation is a?* terwards described as " the effusion of lymph which seals the extremities of divided vessels." What then are these serous membranes j and, if they have any claim to such a term, what analogy have they with parts which effuse lymph? The "writer,, we are aware, will refer us to Bich&t, and to some of his followers in England, but these works are not in every hand ; and, if Mr. Hunter's language is adopted in the term " adhesive inflammation," why are not these membranes called after him, the membranes which line cavities and the cellular membrane, terms which cannot lead into error or confuse. Nor are we satisfied with the mere expression, that " the inflammation produces an effusion of lymph j'* mere effusion would he very inadequate to the purpose of sealing the divided extremitiesy Ave re not this lymph effused in a particular form, that is, were it not immediately separated from the serum and the red particles, and so organized by the formation of vessels communicating with the parts to ?which it adheres as to maintain its life and the situation it has assumed for the important purposes ascribed to it by the author in the above quotation.
Let us now attend to Dr. Farre's case, and the illustration,' added by Mr. Hodgson. " A man (we are told), who had recently returned from Jjnaica, where he had been severely afflicted with dysentery, attacked with violent pneumonia, which destroyed him in the course of five days. The cavities of the pleura were found to on. tain much lymph and serum. The pericardium was covered with lymph. The cells of the lungs were filled with bloody serui% and the bronchia were highly inflamed. All the thoracic viscer exhibited the effects of the highest degree of acute inflammation which had extended also to the aorta, the internal coat of which ^as of a deep red colour, and a considerable effusion of lymph hd taken place into its cavity. The effused lymph was very iutim&ely connected with the internal coat of the vessel, and a plHg of?t had extended into the left subclavian artery, and nearly oblterated the cavity of that vessel. 41 This case exhibits the effects of acute inflammation upon the Internal coat of an artery, and shews the tenden<y which that membrane possesses to assume the adhesive inflammation. A similar state of the great blood vessels is occasionaly met with in violent inflammations of the thoracic viscera. I have seen it in three cases of carditis, pneumonia, and bronchitis, but in none had the effusion proceeded to so great an extent a.c in the instance above related. In one case, the aorta was throughout of a deep scarlet colour; the posterior mediastinum was gorged with serum, and, a little above the semilunar valves, the cellular membrane that connects the coats of the aorta was distended with lymph. This pppditjon of the great arteries has been but little attended to by pathological Mr. Hodgson on Diseases of Arteries and Veins. 133 pathological writers. Morgagni and Boerhaave indeed mention its existence, and impute to it some of the symptoms of suffocation and oppression of the heart, that have been noticed in many thoracic diseases. Portal also remarked it in a young man who died a few days after the repulsion of an acute eruption. The thoracic aorta was very red, swollen, and tender, and its internal coat near the diaphragm was particularly putted and softened. A similar effusion of lymph sometimes takes place in the neighbourhood of ulcerations and calcareous depositions in arteries. I have seen an ulcerated and thickened artery, where a plug of lymph, evidently effused by inflammation, filled the cavity of the common iliac. f< Lymph, which is thus effused into arteries, sometimes becomes the matrix of vessels, and granulations or fungous growths are occasionally the consequences. Granulations are not unfrequently inet with at the origin of theaoita, particularly upon the semilunar valves, and also in the cavities of ihe heart, the lining mem. brane of which is continuous with that of the arteries, and appears to possess the same properties.
" The inflammation which is excited in an artery by the applica. tion of a ligature, is sometimes propagated to a considerable extent along the vessel. I have seen the inflammation of the internal coat extend even to the heart after the ligature of the femoral artery in amputation, and I have known a similar effect produced by the application of a ligature for the cure of an aneurism in the upper extremity. Mr. Cline and Mr. Abcrnethy hare also observed this circumstance after the ligature of the femoral artery for the cure of aneurisms; and it has been remarked in the hypogastric arteries, after the ligature of the umbilical cord." Here every part was violently inflamed, and the blood partook of the same increased action, the only effect of which is its coagulation with greater or less rapidity and firmness. That* the blood often coagulates in the internal coat of an artery cannot be questioned, but this should not be called the adhesive inflammation, as adhesions are not always formed, and sometimes the coagula are formed without any apparent inflammation in the vessel. In cases of extensive mortification, the blood will coagulate in the vessels leading to the heart; under extensive suppurations the same will take place, and, in the article of death, it is well known, that coagula are often formed in the heart, or the larger vessels, preserving the exact figure of the cavities. Even the red appearance of an artery is, as Mr. Hodgson remarks, a very uncertain test of inflammation. " The internal coat is of a deep scarlet colour, sometimes throughout the whole extent of the system; and on other occasions thisappearance is to be observed only in circumscribed patches.
It is attended with no deposition of lymph, or thickening of the yesselj and, if the internal coat be removed, the middle generally presents 134 Critical Analysis, presents its batural appearance; whereas, in the cases of acute In* flammation which I have examined, the middle coat has always exhibited a preternatural degree of vascularity. This red appearance of the internal surface of an artery is often observed in the vicinity of coagula, and in those instances may probably be the effect of transudation after death. But I have very frequently remarked it where no coagulum has been found in the vessel, and it is generally to be observed in arteries that have been long exposed to the air in the dissecting room. I have, however, seen it in sub. jects that have been inspected a very few hours after death, and eannot, therefore, regard it as produced merely by exposure to the air. Whether it is to be considered as a change which takes place after death, or as a morbid appearance, I am unable to determine. Corvisart says, that it has been regarded as the cause of a peculiar fever, and that Dr. Frank had observed it in nineteen instances of that disease." This passage contains a very proper hint on the necessity of distinguishing the red appearance which the coat of an artery acquires by long exposure, and that which occurs on its first examination. The former is imputed to the wellknown effect of the air on blood, and the latter to the peculiar properties of the inflammation, namely, the presence of a greater quantity of arterial blood, and the increased number of small vessels carrying red blood. But the tyro will ask, why is this length of time necessary to produce such a change in the appearance of the blood ? " I have seen it, (says Mr. Hodgson) in subjects that have been inspected a few hours after death, and cannot therefore regard it as produced merely by exposure to air." Now, it is well known, that a very short exposure to air is sufficient to give this red appearance to the blood. Why, then, should we not see in a recent subject, as well as " in arteries which have been long exposed in the dissecting room." No doubt, the author was so well aware of the cause as scarcely to think it necessary to explain it; hut we, who meet with readers of every description, feel it our duty to give some opinion on the cause of this difference. In a recent subject, the blood is contained in vessels which are not pervious to the air, because they retain their-life. That the air cannot produce this effect through a living substance, however thin, is evident, because ive find, when stagnating in the lips of asthmatic people, it never acquires its crimson appearance. But that it will absorb oxygen through a much thicker membrane, and through a large quantity of serum, is evident by Dr. Priestly's experiment through a common bladder, and by the appearance constantly discovered, when blood taken from the arm is left to coagulate in a basin, and the red parts are covered by serum.
We Mr. Hodgson on Diseases of Arteries and Veins. 135 We submit it to Mr. Hodgson and our readers, whether we should not impute it to the permeability of dead animal matter to the air, whilst living matter resists it. Hence the change often perceived in the countenance of a dead subject.
But the individual parts retain life after respiration has ceased, which is proved by the continuance of irritability ; and, as long as this life continues, so long will the blood in the subcutaneous vessels retain its purple appearance. At length the parts, ceasing to live, are permeable to air, and the chemical properties of the air shew themselves in the altered colour of the blood. e{ Arteries (continues Mr. Hodgson) are also subject to chronic inflammation, which lays the foundation of various morbid alterations in their coats. Chronic inflammation is generally to be observed in thickened and calcareous arteries, particularly in aneu. rismal subjects. In some instances it may probably he regarded as the effect of those diseases, although it is more probable that such depositions or alterations of structure are caused by increased vascular action. The internal coat of the vessel is soft, thickened, and of a deep red colour, which is not uniform, but irregularly disposed in the vicinity of ulcerations, thickenings, or calcareous depositions. This appearance in arteries has long been known, and accurately described by various authors, and the ancient physicians ascribed it to the eflects of the morbid, acrimonious, syphilitic, and scorbutic humours that pervaded the system. Some modern writers also, and among others Scarpa, Corvisart, and Richerand, are inclined to impute it to similar causes, and particularly to the action of the syphilitic virus, or of the mercury that is used for the cure of that disease. From my own observation, I may remark, that I have, for the most part, found aneurism, and those organic alterations which generally attend the formation of aneurism, in subjects that have suffered much from venereal diseases, and who have taken large quantities of mercury. It appears, indeed, by no means improbable, that the internal coat of arteries may be one of those parts over which some specific diseases may exert their peculiar influence. Our knowledge on this subject is at least not sufficiently extensive to warrant the total rejection of opinions which derive some authority from observation, although our information is too hypothetical to be regarded as placing the subject in the condition of an established fact. It is, therefore, mentioned at present only as an object worthy of attention," Whatever objections we may have to the above paragraph, the modesty of the conclusion is an example we shall keep in view and which we trust our remarks will not contradict. We do not recollect any ancient author who suggests a venereal cause in these diseases excepting Lancisi. But we know that, at one time, whatever could not be otherwise explained was referred to this as one common cause, and, in , ~ our 136 Critical Analysts, our present eagerness to make amends for past errors, perhaps we impute as much to mercury* This would be well, if it led to a more exact inquiry into the effects of the disease and the remedy ; but, is the practice of any of us yet freed from empiricism in the use of that mineral ? where an artery has suffered so much violence as to be thickened with calcareous depositions in the manner described in the above extract, we should suspect that this mischief had been effected by an acute inflammation, the property of which in arteries is, we know, to produce the secretion of calculous matter. If the patient survives the inflammatory attack, the artery is very likely to assume this form, and the disease may now be called chronic, but we suspect its origin was acute. Ossifications, without any breach in the substance, we should rather consider the effect of chronic inflammation. It may not be amiss, in this place, to offer a conjecture on the cause of that disposition to secrete phosphate of lime in diseased arteries. Is it that their elastic coat partakes of the property of cartilage, and under inflammation takes on the ossific process, as Ave find in inflammation of bones; and does the covering membrane partake of that property like the periosteum ? But may we not, also, account tor the disposition in old people to ossifications in the larger arteries, without any apparent inflammation, by the well known property of cartilage to ossify ; or has there been, in these subjects, an inflammation so chronic as to induce this gradual ?hange without pain, and to which the parts accommodate themselves almost without inconvenience. The ossification of valves, which, being inelastic, are not likely to be cartilaginous, may be an objection to this. But are we sure that the hardness of valves is from a deposition of calculous matter ? The next section is on Ulceration of the Coats of Arteries.
?An effect which, if not induced by external violence, we should always impute to previous inflammation, by which the texture of the artery was so much injured as to render suppuration the necessary consequence. quantity of pus. Pus, however, is rarely seen about these ulcers, because it is no sooner secreted than it is washed away by the stream of blood passing through the vessel. It is not improbable that the internal coat of arteries, during inflammation, may secrete pus without the existence of ulceration, as sometimes it happens in 6erous membranes. The current, however, through the vessel would prevent such a state being distinguishable." Some very good remarks follow concerning the destruc* tion of the whole substance of an artery in the ulcerated parts, producing apoplexy, if in brain, or hsemorrhage, ac? cording to the situation of the vessel. We think it right to transcribe the section on Sphacelation of the Coats of Arteries, as a further means Of illustrating the difference between the adhesive inflammation and the mere coagulation of blood.
"Inflammation, when confined to the internal coat of arteries, very rarely terminates in sphacelation, at least I have not been able to meet with the circumstance upon record, nor have my own observations afforded any instances of it. Arteries, however, are frequently involved in the sloughing of surrounding parts, ia which case the blood generally coagulates in the vessel to a consi? derable extent above the line of sphacelation. This circumstance prevents the accession of hemorrhage upon the separation of the 6lough : and, the coagulum being subsequently absorbed, the vessel contracts, and is ultimately obliterated. The cause of the forma* tion of this coagulum is by no means evident, although it is proba? ble that the condition of the mortified vessel interrupts the passage of the blood through it, arid a coagulum is consequently formed* extending to the next important collateral branch. Amputation is sometimes performed a little above the line of separation in which It is unnecessary to tie the arteries, and parts destroyed by sphace* lation generally separate without the occurrence of haemorrhage^ the cavities of the vessels being plugged with coagulum." This is a process particularly noticed by Mr. Hunter, and produced among his proofs of the vitality of the blood, and that its coagulation arises from the impression it receives. Ia the present instance, he imputes the coagulation of the blood to the same laws by which the artery afterwards contracts, and the coagulum is absorbed, namely, to those powers of preservation u which, (to use the language of that distin* guished pathologist,) evinces life in every part of an animal bod}-, and renders every part of a living body susceptible of impressions which excite actions." In this manner alone he attempts to account for the coagulation of blood under morti* 158 Critical Analysis* tion for mortification ; in this case, the blood coagulates even in the larger vessels. " I have seen (continues Mr. Hunter,) a mortification' come on in the foot and leg, and5 when it had advanced to a certain degree, the person died. On examining the parts above the mortified part, I found the crural and the iliac arteries filled with strong coagulated blood. We may thence infer, that the tendency to mortification in the vessel produced this disposition in the blood. If the coagulation should be supposed to have arisen from the blood being stopped in the larger vessels at the mortified parts, let us reflect that this cannot account for it. The same thing ought to happen in an amputation, and in any case where the large vessels are tied up."?By this, it is evident that the interruption to the passage of the blood is not necessary to produce coagulation in the vessels j it is well known that it tately happens frbm that cause. fhe fourth section is of the various Morbid Appearances in the Coats of the Arteries. Much of this has b^en already anticipated, particularly what relates to ulceration and the deposition of calcareous matter. Some appearances are, however, more minutely described.
J Bail lie's Morbid Anatomy, p. 45. \ Treatise on Blood, &c. p. 55* ' 1 " ' " "" "But " Mr* Hodgson on Diseases of Arteries and Veins. 141 " But there is some degree of uniformity in this diseased state of the vessel, for the same morbid alterations are found in various parts of the sac; and this circumstancc appears to me to prove that the coats of the artery compose the disease, for it is the internal coat in which calcareous matter is deposited ; and, if we find that substance in all parts of the sac, it appears fair to infer, that the internal coat enters into its composition, inasmuch as .that " identity of disease indicates identity of structure. This menu brane, indeed, is much thickened, and resembles the peritoneum in an old herniary sac. Smaller sacs or pouches often grow l'ron^ the sides of the great cyst, and are lined with a calcareous crust.
At other timesj the dilated coals appear to have given way at some point, and an aneurism is thus, as it were, ingrafted upon the dilated artery. This circumstance has, no doubt, tended very much to confound the disease with aneurism ; but in such cases the part at which the neck of the sac commences is very evident, and its lining does not present those morbid appear, ances peculiar to the coats of arteries. There is also another circumstance in which this disease differs from most aneurisms, namely, that such dilatations very rarely or never contain any lamellated coagulum. Mr. Allan Burns has mentioned an instance in which some layers of coagulum were deposited ; but the dilatation had, in that case, proceeded to such an extent, as to cause fissures in the coats of the sac in which the fibrine of the blood had been deposited. The dilatation often terminates abruptly at the arch of the aorta, but at other times it gradually diminishes-Sometimes the dilatation is partial, and occupies only one side of the vessel, which is expanded into a pouch, having much the appearance of an aneurism ; but such partial dilatations very rarely contain lamellated coagulum. The essential differences between the two diseases will be considered wheu treating of the formation of aneurism." This is contained in the succeeding chapter, Avhich makes the first of the second division of the work.
" When the coats of an artery have given way from any of the causes detailed in the preceding part of this treatise, such as ulceration, dilatation, or rupture, and the blood passes into a cyst formed by the condensed surrounding parts, so as to be out of the course of the circulation, the disease is termed aneurism. Aneurism is also said to exist when an artery being wounded, and the integuments above that wound being united, the blood is effused into the parts immediately surrounding the vessel, and forms by its pressure a sac which has no external opening. There are other diseases of the vascular system to which the term aneurism has been applied, but at present I shall consider only that variety which is produced by the disorganization of the coats of an artery from an internal cause. " Section t. On the Formation of Aneurism in general.?' Notwithstanding the attention which has been given to this branch 142 Critical Analysis. branch of pathology, there exists much uncertainty as to the na? ture of the parts which form an aneurismal sac. The question is simply this : Does aneurism ever consist in a general or partial dilatation of all the coats of an artery, or is it constantly produced by the destruction of all or most of these coats, and the formation of a sac by the influx of the blood into the sheath of the vessel and surroundiog parts ? u The controversies which have existed upon this subject appear to have arisen from a reluctance to admit the possibility of more than one cause in the production of the same effect, and from an adherence to opinions deduced from very imperfect observations. As the ancients did not examine morbid appearances by dissection, their opinions on all subjects which, like the present, can be decided only by anatomy, must be merely speculative, and of no value. It therefore can be of little consequence whether iEtius and Paulus did or did not describe aneurism as formed by a dilatation of the coats of an artery, or whether they agreed with most of the other Greeks and with the Arabians in defining aneurism to consist in the rupture of an artery and the effusion of blood into the surrounding parts. Vesalius first applied anatomy to the investigation of disease, and he described an aneurism arising from the rupture of a dilated aorta. Subsequent examinations by Sennertus, Elseuerus, Silvaticus, Severinus, llildanus, Barbette, and others, produced the doctrine that aneurism is universally caused by rupture of the proper coats of an artery. In the mean time, Fernelius advanced the doctrine that aneurism is produced by a dilatation of all the coats of an artery, similar fo that dilatation ?which takes place in veins affected with varix. This opinion was supported also by Forrestus, Diemerbroek, and other writers. Further observations gave rise to a third opinion ; and the cases recorded by Lancisi, Friend, Guatrani, and Morgagni, seemed to prove that aneurism may be occasioncd cither by the rupture or by the dilatation of the coats of an artery, or by a combination of both circumstances, the dilatation having preceded the rupture.
Systematic writers adopted this doctrine with regard to the formation of aneurism, and the different varieties of the disease were distinguished by the terms?the true, the spurious, or the mixed aneurism. In the true aneurism, a sac was described as formed by a dilatation of the coats of the artery ; in the spurious, the coats of the vessel were said to be destroyed, and the surrounding parts to form the sac; and the term mixed implied that variety in which the coats of the vessel were dilated to a certain extent, and subsequently by their destruction the true aneurism was converted into the spurious. Innumerable cases were recorded in which the sac appeared to be formed either by dilatation or rupture of the coats of the vessel, and upon these opinions and facts was grounded the doctrine generally received with regard to the formation of aneurism, until the publication of Scarpa's elaborate treatise. This indefatigable anatomist has revived the doctrine of Sennertus, and contends that aneurism is never produced by a dilatation, u but by a corrosion and rupture of the proper coats of the artery, and consequently consequently by the effusion of arterial blood under the cellular sheath, or any other membrane which covers externally the injured artery." My own observations will not allow me to coincide with Scarpa, in defining aneurism to be constantly produced by a destruction of the coais of an artery. On the contrary, the inspection of innumerable preparations of this disease contained in the principal museums of this metropolis, and the more minute examination by dissection ofTarious specimens of diseased arteries, and Of aneurisms in the different stages of their formation, have produced a conviction in my mind, that, although in most ancurismal sacs, especially in those which have arrived at a considerable size, the coats of the vessel have given way, yet in a great proportion of aneurisms the disease commenced in a partial dilatation of the coats of the artery. The evidence upon which this opinion is founded will be detailed in the following observations on % the 144 Critical Analysis; the formation of aneurisms, 1st, by destruction * and, 2dly, by a partial dilatation of the coats of the vessel. " A great proportion of the aneurismal sacs which I have had an opportunity of examining, were unquestionably formed in the manner which Scarpa has described, namely, by a destruction of the internal and middle coats of the artery, and the expansion of the external or cellular coat into a sac. The cellular coat at length gives way, and the sheath of the artery and the surrounding parts form the boundary of the tumour. When the internal and middle coats of an artery are divided, and air or water is injected into the vessel, the external coat bulges very considerably, and constitutes a small aneurismal sac. ?Sicholls exhibited this ex. periment to the Royal Society by injecting water into the pulmonary artery with such a degree of force, that he ruptured the internal and middle coats, and distended the external. I have frequently repeated the experiment by dividing the internal and middle coats of different arteries by the application of a ligature, which being removed, and the vessel forcibly inflated, the external coat has always exhibited a sufficient degree of dilatation to prove that it is more liable to yield and to be expanded into a sac, than to be ruptured by the impulse of the circulating blood. It appears, therefore, that, when the internal and middle coats are destroyed, the sac is in the first instance formed by an expansion of the external coat of the artery: as the distension advances this membrane gradually gives way; the sheath of the vessel then restrains the effusion, and, yielding in its turn, the surrounding parts, whatever may be their texture, form the walls of the extravasation. The inflammation that is excited in the coats of the artery by the primary disease, and subsequently in the surrounding parts by their distention, produces amongst them an effusion of lymph which glues them together, and prevents the effusion of blood into thecellular membrane. Thus is the sac formed, and the inflammation which exists within it produces an effusion of lymph with which its internal surface is lined like that of an abscess. u The causes which give rise to the destruction of the internal and middle coats of an artery, are ulceration and rupture. Ulceration, as 1 .have already observed, is rarely met with in the coats of an artery which have not undergone some previous morbid alteration. It, however, frequently takes place in arteries the coats of which contain atheromatous or calcareous depositions. The in.
ternal coat first gives way: the destruction of the middle follows, and is accelerated by the infiltration of the blood amongst its fibres. The external coat becomes incapable of resisting the force of the circulation, and yields so as to form the sac of the aneurism. My friend Mr. Brodie favoured me with a diseased and thickened aorta, which exhibited these processes in a very early stage. Th& internal and middle coats were destroyed apparently by ulceration, and the external was expanded into a small pouch not larger than a pea. ^ The formation of an aneurismal tumour, in the generality of cases, Mr. Hodgson on Diseases of Arteries and Veins, 145 cases, Is preceded by rupture of the internal and middle coats of the artery ; the destruction of these coats by ulceration is a less frequent cause of aneurism. When the internal coat has under, gone those morbid changes which I have described under the denominations of the steatomatous and cartilaginous thickenings, on when calcareous matter is deposited in its substance, it frequently cracks and hangs in scales into the cavity of the vessel. The dis, ease is sometimes so extensive, that the middle coat becomes in* volved in it ; the fissure extends throughout its substance, and its fibres are readily separated by the impulse of the circulation. The blood thus comes in contact with the external coat, which is di* lated into a sac, in the same manner as when the internal and middle coats arc destroyed by ulceration. The aorta of a lady, whose case I have already detailed, illustrated this stage of the formation of aneurism. The internal coat was throughout pop. verted into cartilage, or covered with calcareous depositions. At the arch of the aorta there was a transverse rent about an inch in length, which had penetrated also the middle coat. The blood had insinuated itself between the middle and external coats, the latter of which was elevated into a tumour about two inches in circumference, and presented the appearance of a circumscribed ecchymosis. I conceive, that, had the patient survived, this con^ dition of the aorta would have given rise to the formation of aa aneurism. A similar appearance was observed by Nicholls iq the examination of the body of George the Second. " Jn the trunk of the aorta, says Nicholls, u we found a transverse fissure on its inner side about an inch and a half long, from which some blood had recently passed under its' external coat, and formed an ele, vated ecchymosis." The laceration of the internal and middle coats of the artery generally takes place during some violent ex.
crtion. Having lost its natural elasticity by the disorganization of its structures, the artery is unable to resist the impulse of the circulation ; and hence patients generally date the commencement of their aneurisms from the occurrence of some accident or violent exertion. I have never, however, met with the laceration of the coats of an artery which had not undergone some previous morbid alteration, nop do I think it probable that any exertion which did not lacerate the surrounding parts could be sufficient to rupture the coats of a healthy vessel. Richerand says, that by violeptly extending the leg upon the thigh the internal and middle coats of the popliteal artery are ruptured, and thus he accounts for the frequency of aneurisms in the ham. 1 have several times repeated this experiment, but have never lacerated the coats of the artery unless the degree of violence was sufficient at the same time to rupture the ligaments of the knee, an event which can rarely be supposed to take placc in those accidents to which the origin of aneurisms is attributed. Again, the experiments of Dr. Jones* * Jones on Haemorrhage, p. 125, no. 1<)8. u prove 146 Critical Analysis* . prove that the sudden laceration of the internal and middle caa{3 . of a healthy artery is not followed by the formation of an aneu.
.rism. .An effusion of lymph takes place, which renders the vessel .more firm at that part. Mr. Hunter and Sir Everard Home* also peeled off the external coats of an artery in a living animal, to ascertain whether a deficiency of these coats would be attended with a dilatation of the internal, but they found that dilatation was not the consequence, and the effusion of lymph which took place upon the artery rendered it more firm and less capable of dilatation than in its natural state. The constant existence of disease In the coats of every artery which is the seat of aneurism, renders .It probable, therefore, that the loss of elasticity predisposes to laceration from causes which would not be productive of that effect . in a vessel which possessed its healthy properties. " The destruction of the coats of the vessel generally takes place in a transverse direction. Sometimes, more especially in the .arteries of the third order, the whole circle of the vessel is separated, and in" other instances the division is partial, and the artery , appears as if it had been opened by an instrument. Sometimes the destruction of the coats takes place in a longitudinal direction ; sometimes it has a circular appearance, and its edges form a parti.
tion between the cavity of the sac and that of the artery.
" Cases in which aneurisms appear to have been produced by ..destruction of the coats of the vessel, abound in surgical acid 1 pathological writings. It is sufficient, however, in confirmation of ;the facts which I have stated, to refer ta those recorded by Scarpa, Morgagni, Lancisi, Guattani, Desault, Warner, and Home, and.
to the plates of ,Scarpa and Guattani. IJut is every aneurism produced by a destruction of the inter, nal and middle coats of the vessel, and does not a partial dilatation of these coats occasionally precede and give rise to their destruc. tion ? I belieye that this is frequently the case. We have seen that the disorganization of the eoats of an artery by destroying their natural elasticity will give rise to a permanent dilatation of the whole circumferencc of the vessel; and there is every reason to expect that a loss of its elasticity in a portion only of the diameter pf the vessel, will give rise to a partial dilatation of its coats.
Indeed the proofs of a partial dilatation of the coats of an artery, particularly of the aorta, are incontestably established by the pos. sibility of tracing the coats of the vessel throughout the whole extent of the expansion, and by the existence of those morbid appearances in the sac which are peculiar to the coats of arteries. 11 In the year 1811, I dissected an aneurism of the aorta, which .was removed from the body of a young woman by my friend Dr. Farre. The sac was as large as a small melon, and had proved -fatal by bursting into the posterior mediastinum, and subsequently , * Transactions of a Society for the Improvement of Medical and ChirurgicaHLuowledge, vol. i, p. 144. *.?J0 ifito the cavity of the thorax. This aorta exhibited the formation of aneurism by partial dilatation in three distinct stages. The in? tfirnal coat was throughout inflamed, and presented a fleshy and irregular appearance. At the arch of the aorta there was a dilatation not larger than the half of a small pea. About two inches lower in the same vessel was a second dilatation which would have contained a hazel nut, and immediately above the diaphragm was the large aneurism which had proved fatal. I removed that portion of the vessel which contained the smallest dilatation, and macerated it until its coats could be separated without violence. I found that the dilatation existed equally in the three coats of the vessel, and, when separated, each presented the appearance of a minute aneurism. The second dilatation exhibited the same circumstances in a more advanced stage. The coats of the vessel were more intimately adherent to each other than in a natural state; but it was evident that the sac consisted in a dilatation of the internal, the middle, and the external coats of the aorta. In the large aneurism, the disorganized internal and middle coats could be traced for some distance into the sac, when the parts contained in the posterior mediastinum and the vertebras formed the remainder of the cyst. There can be little doubt that this sac commenced in a dilatation of the coats of the vessel similar to those appearances which existed in the superior portion of the artery, and the dissection appeared"to illustrate the formation of aneurism, by partial dilatation of the coats of the artery in three distinct stages." We have given this long extract that we might not interrupt the author unfairly. We shall be very short in our remarks. To us, we confess, that the existence of aneurism, without the previous destruction of some part of the internal coat of an artery, is still problematical. The distinction between a dilated artery and an aneurism, was, we believe, first made bxr Scarpa, and we find it extremely difficult to mark the difference without admitting of Scarpa's conclusion. "The constant existence of disease, (says Mr. Hodgson,) in the coats of every artery which is the seat of aneurism, ren-' ders it probable," &c. If we admit constantly disease, we cannot easily assert that this disease did not exist before the aneurism was formed; and, if the internal coat appears perfect, we cannot assert that it has not been renewed by coagulated lymph, especially when we find calcareous matter below.
Whether, in the case described at the conclusion of our extract, the upper dilatations would have become aneurism, we cannot ascertain, as Mr. Hodgson has not mentioned whether they contained any strata of lymph which he conceives characteristic of aneurism. Perhaps it will be found that the distinction is less important than it may seem, as all parties jnust, we conceive, adnait that the artery is diseased before it has lost its (elasticity. The construction of an artery to preserve its form by the elastic power conjoined with the tauscular, is so beautifully described by Mr. Hunter, that toe felt perpetually disappointed in finding so little notice taken of the labours of that wonderful physiologist. In referring to page 129 of his Treatise on the Blood, it will bd seen how accurately the whole question of elasticity and dn latation had been examined by him. The fair inference of all his observations would lead us to conclude that, as long as the artery retains its original elastic powers, the force of the heart can never produce any partial dilatation ; that, "Whenever it loses its elastic power, it must either dilate of give way. In the first case we shall have the dilated artery, in the second the aneurism.
From a careful examination of Dr. Jones's experiments* it is not very difficult to Conceive, that injury* similar, excepting in degree, may produce aneurism, or dilatation, or obliteration of the cavity. For a further account of these expe* riments, we refer our readers to Vol. XVI. p. 89, of our Journal. By these he will find that the degree of division of the internal coat becomes the stimulus to the future action of the vasa vasorum of the surrounding parts, and of the blood itself. It will there also be found* " that the sudden lacera* tion of the internal and middle coat of a healthy artery is followed for the most part by an effusion of lymph, which not only renders the artery firmer, but in many cases oblite-* fates it altogether. Mr. Hunter and Sir Everard Home's Experiments are sufficient to shew, that mere weakness from mutilation without disease in an artery* may be repaired before dilatation takes place, consequently, that the latter can only happen when the artery is so far disorganized that its elasticity is irrecoverably lost.
We have made these remarks not with any wish to detract from Mr. Hodgson's merit, of which we are highly sensible, but to shew, from the magnitude and complicated nature of the subjects, how necessary it is minutely to examine all their bearings, and whatever has been done before us.
The author next proceeds to the spontaneous cure and Inedical treatment of aneurism; a section which abounds Ivith good sense and close observation. Of the spontaneous cure under different circumstances, the author gives many interesting, and we may add consolatory, cases. His proposals for medical treatment are not less judicious. The general conclusion drawn from this division of the work is? " First. The deposition of coagulum in the cavity of the aneu* rismal sac and the artery leading into it, is the mode by which the Spontaneous cure of aneurisms is, in most instances, effected. % " Secondly.
Mrk Hodgson on Diseases of Arteries and Veins. 149 Secondly. The coagulum is subsequently absorbed, and the Sac and the artery contract until the one becomes an impervious cylinder, and the other a small fleshy tumour* <( Thirdly. In some instances the cure is effected by the obliteration of the cavity of the sac without any obstruction taking place in the calibre of the artery from which the disease origin nates; in this manner a cure may take place in aneurisms of the aorta.
(< Fourthly. The formation of coagulum being a general occur, fence in aneurisms, it is an important object to preveut the increase of the sac, that the deposition of coagulum may proceed to such an extent as to obliterate its cavity.
u Lastly. It is the force of the circulation which causes the enlargement of the sac and its ultimate rupture; hence the diminution of the force of the circulation is the principal indication in promoting the spontaneous cure of aneurisms." A section follows on the Surgical Treatment oj Aneurism, and on Collateral Circulation. This is necessarily very minute, and we may add very judicious ; we need not inform our surgical readers that it will not admit of being epitomized.
Having thus gone through the general process of disease in the arteries, and considered the various causes, progress, and diagnosis of aneurism, with the mode of treatment, Mr. Hodgson proceeds to offer a section on each kind of aneurism as distinguished by name and situation, on aneurisms arising from wounded arteries, and on the varicose aneurism, as well as aneurismal varix.
The fourth part is on the Diseases of Veins ; on Inflammation on various Morbid Appearances in their Coats; on their Obliteration and the consequent Collateral Circulation ; on varicose Veins, Cirsocele, and Haemorroids, which last the author conceives arise sometimes from the veins. If we concede this to him, we are not prepared to admit that any of the periodical bleedings from those parts are venous, because in all the cases we have seen, which are numerous, the appearance of the blood at its first discharge is truly arterial. This is, however, a mere matter of opinion, and of little importance.
An Appendix follows, replete with interesting matter, not easily introduced in the work itself. The first paper is an account of worms found in the arteries of some animals.
These are principally in horses and asses. The latter have been examined by the author with much attention.
His description is very minute, and, we doubt not, equally accurate.
We agree with him, that the accounts of worms in the human arteries are not satisfactory ; but we could refer to other testimonies of worms found in the heart of dogs 1,>0 Critical Analysis.' dogs of the description mentioned by M. Peyssoii, andf also to a living witness, who found them in several dogs during' the time that an epidemic disease prevailed in that race. It is not certain that the worms were the cause of the disease, as they were not found in all that were examined.
A very interesting case follows, in which there was an ob-.
iteration of the brachial, radial, ulnar, femoral, popliteal, and tibial arteries.?-A case of popliteal aneurism, cured by the obliteration of the femoral artery, under the use of Professor Assalini's forceps, of which a drawing will be found in page 2 of our last Number. This case we have given in our Collectanea.?A Case of carotid aneurism ; a case of axillary aneurism, by Mr. Thomas Blizard, in which the subclavian artery was tied. This we have also reserved for our Collectanea, as it is, we believe, the first instance in these important operations in which the patient lived long enough to shew that the collateral branches were insufficient to carry on the circulation in time to preserve the most extreme parts. The operation and the relation of it does equal honour to the judgment and candour of that distinguished surgeon.
Such are the contents of this valuable performance : as we have not been backward in offering our opinion of every part particularly noticed, we have onlj' to remark, that the whole does great honour to Mr. Hodgson's industry and genius. We have no doubt that the book will be considered a text book, and be referred to in all subsequent experiments, as well as operations on these delicate organs. In some parts, if we do not think with the author, our remarks should be rather considered as difference of opinion than real objections. We regret that the work must be so expensive, on account of. the numerous well-executed engravings ; and we cannot help adding, that we have found some of the descriptions quite sufficient, which the author has thought it necessary tq illustrate by drawings. The object of the author seems to be an attempt to reduce the causes of Cancer to a few simple principles, to prove the locality of the disease, and to disprove the existence of what has been termed a cancerous diathesis. A careful perusal of the work, however, has not enabled us to perceive Dr. Rod man on Cancer in the Female Breast. 151 jpercei vethe success of the attempt, or to admit many of the cases stated by the author to have been cases of cancer ; yet several of the diseased breasts, which came under his care, had been condemned to the knife by preceding surgeons. The facility with, which some of these were cured by simple applications, proved, indeed, the ignorance of surgeons who could do nothing without the knife, but it by no means established the cases as,instances of cancer, or justified the author's scepticism, we would almost say, disbelief, of the existence of the disease as one differing in its nature, appearance, and symptoms, from any other disease.
He commences with some observations on the Feeble Structure of the Female Constitution, of which the following is a specimen. u The pursuits of life present a vast mixture of inducements by which mankind is allured ; and the female sex display great anxiety to occupy their several department!? with activity. The strength of every individual, however, is not alike suited for the continuance of this activity, and many females pine under the exertion, with marks of disease aud evidences of lingering constitutional frailty. Yet nevertheless, of such disadvantages, some survive the ordinary periods of existence under calm composure and steady deportment, while others fall victims to premature disease, the consequence of negligence, and the result of delicacy." We extract no more of this part of the work, because the remarks, though sensible enough, are such as would probably occur to most practitioners, and do not apply to cancer more than to many other diseases; yet the author deems them very important, for he concludes? " Probably the reader, by this time, after what he has himself observed corroborative of what have (has) been here stated, will .be enabled to remove the veil and see the fallacy of the opinion that latent powers, hidden malignancy, or occult poison, pervade the system in the production of mammary cancer; and will be inclined to lay aside all the theories that are founded upon such speculations, particularly if his own observations confirm the subsequent state, ments, which, along with the cases, are intended to shew how local affections result as ordinary consequences," The chapter on the " disposition of mammary glands, and origination of tumours" contains some judicious remarks; but they apply simply to inflammation of the parts, and not to cancer.
The chapter on "the locality of mammary disease, .arising from affections of the mind," is written to establish a point which no one.will dispute, that females are apt to imagine themselves afflicted with cancer, especially when they Jiave witnessed the disease in their friends, or have been reflecting or conversing much on the subject. In some individuals, the influence of the imagination has even been supposed v to 152 Critical Analysis. to produce a tumour in the breast, with pain, and some of the symptoms of cancer; but in general such affections yield to mild treatment. The author has adduced two cases in support of the opinions advanced in this chapter; we shall state them in his own words, though we do not regard them as cases of cancer ; they, however, serve to illustrate the effects of fancy or imagination. 44An unmarried lady took suddenly ill, and, though her complaints were very irregular, she had sickness, head-ach, quickness of pulse, interrupted breathing, and symptoms of general agitation for some time, which seemed unaccountable; also several other ailments, occasionally, that varied much in the way of affecting her.
"She continued ill for a number of months, and her health was restored at last by sea-bathing, and agreeable society, when I ob* tained the following information.

15<3
Iierself/oC afflicting thoughts which distempered her frame for a long thne after. " itlady consulted me in the year 1797 for an oval tumor in her left frreast, as large as an ordinary plum, which arose from the accidental stroke of a man's elbow. She -had been three months troubled with it before 1 was applied to, and the<jv.hole gland was exceedingly tender, with general swelling, and tegse tumid lym* phatiCS.
, , V " Her habit of body was delicate, and she was subject to sickliness and indigestion, which occasioned other complaints, and generally augmented the uneasy feelings in the mamma. But, whenever a temporary fever was induced by cold, the mammary disorder became painfully worse, and soon appeared as> the chief morbid affection. The treatment first adopted was leeching, when local inflammation was strongly indicated, and general blood-letting, when it became necessary for other affections of the system, that quickened the distemper within the breast.
f "If renewed inflammatory appearances afterward in the breast were moderate, chamomile fomentations and cataplasms became particularly useful. They generally reduced the swelling, and caused an abatement of painful sensations, when resorted to at the commencement of such ailments. The application of warm vinegar, camphorated spirits, and sometimes laudanutri,, frequently proved serviceable.
From time to time she likewise used medicines for the purpose of strengthening the digestive organs, and preserving a soluble state of the bowels. Little persuasion was required in order to force attention to these means. Uncommon weakness in the stomach, or a considerable increase of cosljvcness, soon revived the uneasiness in the mamma, and that uneasiness she carefully noticed. Other local means and plans of an invigorating nature were persued according to circumstances. But the method men. tioned conveys a general view of the mode of prescription, along with pointed care for the preservation of proper warmth in the body, and in the diseased breast, which was-not neglected. With, in three y ;ars the disease was so completely subdued in this way, that little evidence of a mammary tumour could be traced. The body of the gland was only somewhat delicate, and more easily dis. ordered by injurious casualties than the other breast. "In 1809, after the mamma had been long healthy, a female whose welfare interested the lady greatly as an intimate friend, had a breast amputated for a distemper which was pronounced inveterate cancer.
Immediately upon hearing of this event, the lady recollected that there was a similarity of the two disorders about ten years back, and having seen the female not long before the operation without any thing of the kind being spoken of, her alarm was instantaneous. A sudden pain assailed her formerly.diseased breast, and soon rendered her incapable of attention to assist another person in like circumstances. She busily contrasted the complaints and the result; and, because of the violent pain which was fast increasing, she had no doubt of speedily suffering under the mo. 198.
x same 154 Critical Analysis. same kind of operation, and endeavoured to bring her mind into a state of submission. As was to be expected, this attempt increased the evil, and she became inconsolable. Painful swelling of the breast came on to an alarming degree, and I remarked that the other breast gave her no uneasiness even under such mental agitation. The disturbance appeared only in the breast which continued to be the subject of her fear.
"During this state of mind, the whole glandular substance of the mamma became firm and bulky. Lancinating pains were frequent and severe, returning at times with such violence, that close conversation with a stranger in company could not prevent the rapid and involuntary application of her hand upon the affeGted breast. In this manner the disease advanced for several days, and all my endeavours to mitigate her distress proved unavailing, until I gained an ascendency over her perturbed imagination, and brought her to credit my protestations that there was positively no cancer in the breast. After obtaining her confidence in my assertions, composure of mind ensued, the swelling of the breast diminished, and the pains gradually abated. The remedies which she had used to little purpose when the mind was agitated, were now effectual, and removed the disorder. Topical warmth was strongly recom. mended, as being necessary for some time after, and in a few weeks all was well.
We agree with the author in his chapter on "Indurations or Tumours of the Female Breast" that there is sometimes great difficulty in distinguishing scirrhus from some other tumours to which the organ is liable. The chapter on " the Influence of Cold" conveys little instruction, except to those learned professors, who are able to construe the following paragraph.
411 advised her to the use of food, more nourishing than what she had been accustomed to take ; and pointed out the benefit she would derive, from engaging in some occupation which might require moderate activity, and less confinement. She spoke of an opportunity she had of this kind, in the neighbourhood of a medicinal well, and I recommended that she should go there speedily, stating the advantages of proper clothing, and the necessity to preserve the diseased breast in a regular state of warmth.
April 21st, 1812.?An intimate friend of hers called, by desire, to tell me that she pursued the advices respecting exercise, diet, and local warmth, and, in a few months, the mammary tumour vanished, as well as the tumoHrs in the arm.pit. Jt appears that she is now strong and healthy, seeming altogether like a different person from what she was at the time of consultation.

REMARKS.
"This case affords an instance of tumour in the female breast, while a scrophulous affection might be said to exist in the system ; yet she kuew of no such disease in her family, and it was in very early life that she had the ulcer in her neck. At any rate no disease of this kind was spoken of by others who had examined her, and 1 might have remained ignorant of it also, had not a chance circumstance occurred by which I noticed the scar. " Nov. 23d, 1809.?A servant girl, 18 years of age, desired my advice for a tumour in her left breast.
"She was struck accidentally upon the breast about a year ago, and it continued painful for a week or two ; after which she discovered a tumour in the gland, the size of a hazel-nut, though, till lately, she could not complain of having'experienced much trouble from it. " It is three weeks since she was overheated and fatigued, when the breast became uneasy ; and, while in this state, she heard of a woman whose breast was cut off for a complaint of the same nature. As soon as possible, after hearing of this, she went to the surgeon who had operated in the woman's case, and was told, that the tumour was not the worst kind of cancer, yet, as it was doubtful how long it might remain so, her safety would be secured by allowing the operation to be performed pretty early.
"She had no idea that a business of this kind was to take place so soon, for the pains in the gland were very moderate. Nevertheless they increased after this advice, and, now, although six days since the advice was given her, she is evidently disturbed in her mind, x 2 4< Upon 156 Critical Analysis. ^tjpon examining the breast which is swelled, but not greatly^ I find the tumour in the substance of the gland, immediately above the nipple. When I press the gland laterally, the tumour feels bulky by the interposition of glandular substance, but by pressing directly down upon it, the size is trifling, only the substance around it is firmer than usual. There is no other affection that deserves to be noticed.
"From the good state of her health, I had every reason to assure her that she had no danger to fear, provided she covered the breast with one or two folds of flannel, and took care to bathe it frequently with warm vinegar. These advices she readily engaged to follow, and seemed determined carefully to avoid every chance of injury either by pressure or otherwise.
Dec. 18th.?Her breast is quite free from pains, and the glandular Swelling is gone?the firmness of the glandular substance is greatly dispersed, and the site of what was thought to be a tumour is perceived with difficulty. Fifteen months after this time, she had no complaint of the kind. *' Mrs.' has been twelve months in a state of nervous weakness, with fluor albus, general debility, frequent uneasiness about the region of the stomach, and little appetite for food. Her circumstances in life have been adverse, and her spirits are usually depressed. It is six months since she discovered a painful tumour in her left breast, for the treatment of which a surgeon has attended lier occasionally, during a great part of that time. But, on finding that no remedy proved effectual, and that the mammary disease was still increasing, he seemed alarmed at the nature of her complaints, and proposed to save her by the amputation of her breast. She applied to me on July 5th, 1813.
fi The tumour is lodged in the upper part of the gland?it is felt like a knobbed body, but can be separated into distinct portion?, careful examination. All the substance of the breast is firmer than natural, and there are two bulky glands in the axilia, though I do not think them very hard. The breast is swelled, painful, and tender?the pains are often excessively severe and darting. Her mental feelings appear as if they approached more to a melancholy, than to a hurry of alarm. The other breast is firmer in some parts of its texture, than that which is common in a state of health, and it might be thought to contain a number of tumours. The menses are eipected in a few days?she is very costive, and feels the effects of cold in the left side of her body, in a very particular ]37 " The breast to be fomented daily with a decoction of chamomile Bowers, and covered attentively with cotton wool/ 11 August 9th.?She has had a nervous fever since last report, and went a few days to the country, after recovering from it? The disease of her breast is mild, and the pains are greatly abated. The same treatment of the breast to be continued.
Sacch. alb. drach. un. M. et in doses duodec. divide. Sig.?One to be taken at night and another in the forenoon. The bowels to be kept open as before.
" Sept 4th.?The swelling and general painl'ulness of the breast increased?numbers of bulky glands to be felt through its substance?sickness and languor of the whole body. She fatigued herself too much for three days last week, and, sinci that, her feelings have been of a feverish nature, and her breast has been more uneasy. Oct. 18th.?Is still better, and has been taking sometimes the bark, and sometimes the steel-powders. No swelled gland to be felt in the arm.pit, and, as for the mamma, there is no disease in it which deserves the name of a tumour. l< She is still to treat the breast carefully, whenever it becomes more painful, at any time, or bulkier than ordinary. .. Several other cases might be extracted to prove the extreme ignorance and culpable precipitancy of several surgeons, (we presume in the author's neighbourhood), in deciding upon the necessity of extirpation, before they had tried proper remedies for restoring the breast to a healthy state.
In this respect Dr. Rodman has great merit; but it appears to us, that he has seen very little of real cancer, and we think it may be inferred, from the general tenor of his observations, that he does not believe in the existence of the disease so denominated ; neither should we, had we witnessed only such cases as those which he has detailed, with a disposition to regard pain, swelling, and induration of the breast, as a simple disease produced by various causes. We have no doubt the author has performed many cures, and been of much service in the district in which he resides; but we appeal to his candour, whether, with his particular notions of the disease, lie has acted fairly in bringing forward such affections under the term of cancer? especially, too, when he does not scruple to avow that " the word cancer is a pame, likewise, without any kind of true meaning; for, whatever it may be thought to imply, it leads into nothing but Critical Analysisi exceeds the ingress; or it may be lost on the side of fulness or plethora, when the ingress of fluids exceeds the egress. " Depletion, again, may be occasioned by preternaturally diminished ingress of chyle; by preternaturally increased egress of cxcretions; by both conjoined.
" Fulness or plethora, on the other hand, may arise from preternaturally increased ingress of chyle; from preternaturally diminished egress of excretions; from both conjoined. I shall take examples of each of these peculiar states of the vascular system., in order to ascertain which of them, if any, belong to a febrile state of the body. " Depletion, arising from diminished ingress, takes place in obstructions of the thoracic duct, impeding the flow of chyle. It happens in those who abstain from food and drink. Depletion occurs from excessive egress in diabetic patients?in excessive lactation?during the menstrual period?and from all natural and artificial haemorrhages. Depletion, again, 'occurs from diminished ingress and increased egress conjoined; in jockeys, who rigidly abstain from drinking, while they create a copious flow of perspiration by means of exercise and external heat. In none of these examples, however, do we find that particular train of symptoms we call fever. t)r. R. Calvert on Fever.
of the vessels. Thi9, indeed, must happen, more or fess, in every case of fever, previous to the declaration of the symptoms* Or, should events occur in time to interrupt the accumulation, and restore the balance, the perceptible symptoms of fever may never occur at all. This state of the vascular system, however, in my opinion, ought to be considered as latent fever, the repeated attacks of which might explain the consequences we frequently observe in those people who have lived long in unhealthy situations, although they themselves have never been conscious of an attack. The repeated influx of fluids' to the internal parts distends the vessels of those parts, and gives rise to those subsequent enlargements of the liver, and spleen in particular, that are so common in those situations. The symptoms of fever then are mere indices of the extent to which the balance of circulation has been lost." Having thus easily determined the nature of fever, the author proceeds to explain more particularly " the effects of diurnal changes of temperature upon the vascular system, as tending to produce a febrile state of the body." As this explanation is altogether beyond our comprehension, wp shall state it in the author's own language, professing that we know as little about a diurnal flux and reflux in the vascular system, and closed pores in the nighty as how.to determine the force employed by the rump of the peacock in, elevating and expanding his splendid tail. We suspect that the author's studies have led him amongst the late class of' mathematical physicians, and that he is an admirer of thfe philosopher who discovered that the celerity of the motion of the excrements through the intestines, was exactly in the inverse ratio of the square of the distances. But to proceed^ the author observes that " A regular and alternate rise and fall of temperature commonly lakes place every four and twenty hour$, according to the absence and presence of the sun, the fountain,of heat; consequently, those who aj*e exposed continually to the tealperature of the atmosphere, suffer a diurnal flux and reflux in the vascular system. During the day, the pores of the skin are open; but, during the night* they become closed, when a vascular plethora, takes place; that in warm latitudes this change takes place more suddenly than ip cool ones, from the more sudden rising and setting of the sun: that ip damp situations, where, from the shallowness and opacity of the water, the rays of the sun are obstructed so as to cause rapid evaporation from the surface, the atmosphere, while the sun is up, dissolves a very great quantity of water, with which it becomes saturated; but, the moment the sun goes down, the atmosphere, being no longer able to hold so great a quantity of water in solution, jets go part of it, which we see in the form of fog. The atmosphere now, to use the language of chemistry, becoming a much better conductor of caloric than before, strikes a chilUness into the human frame, shuts up the pores, and stops the flow of JJo, lt)8? y perspiration. 162 Critical Analysts. perspiration. As the intestinal absorption is not so immediate!/ under the influence of the air, it probably continues, so that the fluids begin to accumulate from this moment. If the person i? comfortably lodged, and enjoys repose, the perspiration may be restored during the night, so as to prevent any considerable mis* chief. Or, even if the person be exposed to the night air, the accumulation may go on till morning, when the returning warmth of the sun may restore,the equilibrium, or, at least, restore the fluids to their natural quantify, without the previous accumulation being perceived. " But, should any accidental circumstance occur in the morning <o prevent the return of perspiration; and if, at the same time, the other exciting organs obstinately refuse to transmit the super* abundant fluids, the inconvenience is soon perceived^ A lassitude and drowsiness come on, to which is soon added an aching pain ia the head, back, and limbs, along the course of the large vessels, but usually referred to the bones. These symptoms increase, till, at length, the muscular coats of the vessels are overpowered by the increasing pressure; and it seems to be during this struggle between the vessels and their distending load, that we see those violent cob* vulsions of the frame called shivering.
"The period at which the vascular distention arrives at this pitch, depends, of course, upon the rapidity of the previous ac* cumulation; and, perhaps, in some measure, upon the strength and resistance in the constitution of the patient. The quotidian usually declares itself in the forenoon, when the motion of the body, after a state of rest, probably soon renders the load of fluids insupportable. As, in this form of intermittent, the accumulation is most rapid, so the cold stage is soonest overcome by the increasing fluids; but, as the seat of obstruction is at the surface, and may be more complete than in other forms of the disease, the hot stage is protracted, from the greater difficulty of removing this obstruction. 44 In the tertian, the disproportion between the ingress and egress of fluids being less than in the quotidian, a longer period k 'Required before the vascular system is filled so as to produce a fit; and, for the reasons assigned above, the paroxysm is deferred till a later period of the day: and, from the slowness of accumulation, the cold stage is of longer duration.
? u Inthe quartan, so slow is the vascular accumulation, that aa interval of three days is required before insupportable plenitude ia occasioned. And here again the paroxysm is generally deferred till the afternoon, from the more gradual progress of accumulation. Tho cold stage is longer than in the two preceding forms of the disease.
When the vessels arrive at the inconvenient state of plenitude that occasions a paroxysm, sickness and vomiting, the eommott attendants of vascular plethora, very often occur. I shall notice, 'here, that these symptoms happen when the menses are suppressed ia the first sta^e of pregnancy, in ideopatfcic apoplexy, in nephritic complain {?
Medical and Philosophical Intelligence. 163 Complaints that obstruct the flow, of urine, &c. When fever is aot attended with obstruction in the biliary ducts, the pressure of the fluids accumulated in the liver may create an unusual flow through them, and this may be converted into bile in its passage. It may be again pressed out of the biliary canals by tha mechanical effort of vomiting. Nay, in the most violent cases, the blood seems to be pressed through these canals, either mixed with bile, or imperfectly converted into that secretion. Such appears to be the case in black vomit, or that which resembles coffee-grounds.'* Dr. Calvert, who appears to be a man of considerable observation, was once inclined to adopt the opinion of many others, that the head was the principal part affected in fever, or that it was the seat of the disease; but subsequent experience has convinced him that this is not the case. To support his last opinion, he states the dissection of two heads, one of a patient who died of an acute remittent fever, the other of a patient who died of phthisis pulmonalis. The bodies being covered, and nothing but the brains exposed, the appearances in each were so similar, that neither the doctor nor his assistants could " say which was the fpver patient and which the pulmonic." He thus explains the determination of blood to the head.
(< The fulness of the blood-vessels of the brain, as seen on dis.
faction, depends, in a great measure, upon the position in which the patient dies; for, as the blood after death always flows to the most depending part of the body, it will flow to the head, if that lies low; although, on the other hand, as the pressure of the at. mosphere is taken off by the structure of the cranium, the blood cannot entirely quit the head so as to leave the vessels flaccid," We have now stated enough to enable our readers to judgp of the merits of this ingenious performance, which offers much food for discussion in a medical society.